Comparative Study Of The Effect Of Pathological Subtypes On The Prognosis Of Different Surgery For Stage IA1-IA2 Lung Adenocarcinoma

Objective: To analyze the recurrent metastatic factors after surgery for stage IA1-IA2 lung adenocarcinoma,compare the prognostic impact of different pathological subtypes on lobectomy and sublobar resection,and provide a reference basis for the choice of surgical approach for stage IA1-IA2 lung adenocarcinoma.Methods: In this study,patients with stage IA1-IA2 lung adenocarcinoma who underwent lobectomy or sublobar resection in the department of thoracic surgery at our hospital from January 1,2018 to December 31,2020,and whose postoperative pathology could distinguish the main pathological subtypes,were enrolled in 490 patients.According to the new World Health Organization classification of lung adenocarcinoma in 2015,lepidic predominant adenocarcinoma was classified as low-risk group,acinar predominant adenocarcinoma and papillary predominant adenocarcinoma was classified as intermediate risk group,and micropapillary adenocarcinoma and solid adenocarcinoma was classified as high-risk group.Factors affecting disease-free survival after surgery for stage IA1-IA2 lung adenocarcinoma were analyzed by chi-square test or Fisher exact test,Keplan-Meier survival analysis,univariate and multifactorial COX risk proportional regression models,propensity score matching and disease-free survival and to compare the prognostic differences between different lung adenocarcinoma pathological subtypes after undergoing lobectomy and sublobar resection.Results:1.Analysis of factors associated with recurrent metastasis after IA1-IA2 stage lung adenocarcinoma.In this study,490 patients with stage IA1-IA2 LUAD met the inclusion and exclusion criteria.Keplan-Meier survival analysis showed that patients with stage IA1-IA2 lung adenocarcinoma had a 1-year DFS of 99.2%,2-year DFS of 97.5%,3-year DFS of 95.5%,and 4-year DFS of 91.6%.The results of correlation analysis showed that smoking history,lymph node dissection mode,TNM stage,number of pathological subtype types,and pathological grade had statistically different effects on recurrence and metastasis in patients with stage IA1-IA2 lung adenocarcinoma(P< 0.05).the results of Keplan-Meier survival analysis showed that smoking and TNM stage had statistically different effects on the DFS of patients with stage IA1-IA2 lung adenocarcinoma(P < 0.05);lymph node dissection mode,number of pathological subtype types,and pathological grading had statistically significant differences on the effect of DFS in patients with stage IA1-IA2 lung adenocarcinoma(P < 0.01).The results of univariate and multifactorial COX risk proportional model analysis showed that smoking(HR:2.915 95% CI: 1.079-7.879 P < 0.05),uncleared and sampled lymph nodes(HR: 8.780 95% CI: 2.103-36.669 P < 0.01),and pathological subtype high risk group(HR:14.017 95% CI.3.847-51.017 P < 0.01)were independent risk factors for postoperative DFS in stage IA1-IA2 lung adenocarcinoma.2.Prognostic differences between lobectomy and sublobar resection in the pathological subtype high-risk group.There was a statistically significant difference in the distribution of prognostic factors lymph node clearance modality between lobectomy and sublobar resection groups(P < 0.01).the results of Keplan-Meier survival analysis showed a statistically significant difference(P < 0.05)in the effect of lobectomy and sublobar resection on postoperative DFS of stage IA1-IA2 lung adenocarcinoma,and DFS was better after lobectomy than sublobar resection;different The effect of lymph node dissection on DFS was statistically different(P < 0.01),and postoperative DFS was worse in the non-dissected and sampled groups.Univariate and multifactorial COX risk proportional model analysis showed no statistical difference in the effect of surgical modality on DFS(P > 0.05),and uncleared and sampled lymph nodes(HR = 5.65195% CI 1.221-26.151 P < 0.05)were independent risk factors affecting the prognosis of the pathological subtype high-risk group.3.Prognostic differences between lobectomy and sublobar resection in pathological subtype low to intermediate risk groupsThe results of the Keplan-Meier survival analysis showed no statistical difference in DFS after lobectomy versus sublobar resection(P > 0.05),and after balancing the differences between groups by propensity score matching,the results showed that there was still no statistical difference in the effect of the two surgical approaches on postoperative DFS(P > 0.05).Conclusion(s):1.Smoking,TNM stage,mode of lymph node clearance,number of containing pathological subtypes,and grade of pathological subtypes may be prognostic factors affecting stage IA1-IA2 lung adenocarcinoma.Smoking,undissected and sampled lymph nodes,micropapillary adenocarcinoma and solid adenocarcinoma may be independent risk factors affecting the prognosis of stage IA1-IA2 lung adenocarcinoma.2.High-risk pathologic subtypes of stage IA1-IA2 lung adenocarcinoma may achieve a prognosis similar to lobectomy after lymph node sampling or dissection.3.Sublobar resection of stage IA1-IA2 lung adenocarcinoma with low to intermediate risk pathological subtypes may achieve a prognosis similar to that of lobectomy.